Virginia Heart Disease & Stroke Alliance

Virginia Stroke Systems Task ForceCurrent State Update &

Collaborative Efforts

Rev. Andrea C. LomboyCommunity Education & Web Team Chair

February 3, 2011

Virginia and the Stroke Belt

http://www.cdc.gov/gis/mg_heartdisease_stroke.htm

Virginia Stroke Statistics

Virginia Stroke StatisticsStroke the third leading cause of death in Virginia (2004) - www.cdc.gov/chronicdisease/states/pdf/virginia.pdf

• ~14,000 patients diagnosis of TIA or strokedischarged 85 hospitals IV rt-PA use– Nationally only 2-5% of ischemic stroke patients

received rt-PA– Virginia below national - 0.5% (prior to 2005)– Virginia t-PA use rate tripled - 1.7% (post 10/05)

*Decreased use of tPA may be resultant from a number of contributing factors including: fear, lack of knowledge and/or supervision by a neurologist, and/or medicolegal treatment biases.

JCHC Virginia Stroke Task

Joint Commission on Healthcare (JCHC) Stroke Policy Work Group recommended it’s formation in Jan 2007

• An independent body comprised of stakeholders invested in improving stroke systems of care in Virginia

• Not an advisory body for VDH - facilitated by staff from the Heart Disease and Stroke Prevention Project in the Division of Chronic Disease Prevention and Control

Comprised of:– 30 active members, 30+ stakeholders per meeting– Multidisciplinary, regional representation– Development of statewide work plan

Virginia Stroke Systems Task Force (VSSTF)Formation of VSS

In 2005, the ASA convened a multidisciplinary group, the “Task Force on the Development of Stroke Systems.” Through the work of this group, AHA/ASA recognized the potential value of having each state (2007) follow a newly emerging conceptual framework for stroke care being crafted by this expert committee.

At that time, the AHA/ASA suggested that each state convene a leadership team and begin organizing groups of volunteers and stakeholder organizations to work on customizing a model for their respective states–using a systems-approach and the components of a model stroke system prescribed by the VSSTF.

Stroke stakeholders responded in a statewide network across the Commonwealth to customize a stroke work plan for Virginia including:•The Virginia Department of Health•Healthcare Provider Associations•Office of Emergency Medical Service (OEMS)•Quality-improvement organizations and hospital associations

VSSTF Work Plan

• Avoid state mandated specific protocolsor state PSC accreditation model

• Promote the growth of PSCs and ofregional relationships, correct disparitiesof care (VDH-VTN CAH-HIT initiative)

• Technology one tool (facilitate education,communication, data management,treatment & quality analysis)

VSSTF 2010

• VDH (Office of Family Health Services) convener – American Stroke Association founding partner– 30 members/ 8 quarterly meetings/voluntary– 7 Project Teams– ~30 invited guests (stroke stakeholders)

• In-kind annual contributions $34,585+/yr (w/o industry donation)

ASA Recommendations for Stroke Systems of Care

• VSS Collaborative• Indentified Stroke Stakeholders (300+)• Inventory of current stroke system (3 regional meetings)

Statewide Survey 82 VA Hospitals– Acute Stroke Hospital Role Map (81)

• Developed a Stroke Continuum of Care (Core Work Plan)• EMS Medical Direction Committee (2005) andEMS stroke protocols - Elevated stroke as key issue area

VSSTF Integrated Stroke System

• Partnership development– ASA – “roadmap” successful in other states– Va Department of Health - Office of MinorityHealth and Health Equity– VSS Task Force (300+ stakeholders)– Virginia Telehealth Network (VTN)

Virginia Acute Stroke Telehealth (VAST) Network in partnership with state agencies, academic medical centers and healthcare facilities.

ASA Recommendations for Stroke Systems of Care

“Should ensure that decisions about protocols and patient care are based on what is in the best interests of stroke patients.”– Above geopolitical boundaries or corporate

affiliations– May require collaboration among entities in

neighboring states or political jurisdictionsSchwamm et al Stroke 2005 36:690

http://stroke.ahajournals.org/cgi/content/short/36/3/690

VSS Policy Successes• Virginia Governor Tim Kaine signed HB 479

into law (March 2008)– OEMS will develop base standards– Regional Councils to customize– Consistent protocols based on region-specific

resources (including Primary Stroke Centers), rapid transport, and hospital pre-notification

VSS Policy Successes• All hospitals recommended to establish a

protocol for the rapid evaluation and subsequent admission or transfer

• Centralized EMS electronic medical record data collection

• Care coordination service payments (DMAS)• Expedited Medicaid determination review

(DSS & DMAS)• Uniform destination plans (EMS)

VSS Initiated Resources

VA Stroke Hospital Stratification Map– Survey based, online, VHHA co-supported effort

• VSSAP Stroke Ambassador Program – email format, question/answer database

• The Office of EMS - Statewide release of VirginiaStandard Curriculum: Stroke & Intracranial Hemorrhage (TRAINVirginia: https://va.train.org)

• VSS Website – an umbrella site to concentrate all Virginia specific stroke resources into one central location: virginiastrokesystems.org

VSSTF Committees:

•Acute• VSSCC

•Community Education•EMS•Rehab•Survey•Telestroke•Web

VSSAP (Ambassador Panel)Purpose of the VSS AP: The VSS Ambassador Panel (VSS AP) was established to aid in the development of Primary Stroke Center’s (PSC's) and integrated stoke systems. It is a statewide-accessible program that is comprised of an 11-member team of recognized and dedicated stroke professionals invested in providing the best stroke care possible.

The VSSAP is a single, reliable and free resource for questions regarding stroke program design, development, evaluation and performance improvement. There is no charge for this service.

Email: VA.STROKESYSTEMS@HEART.ORG

Virginia Stroke Systems Coordinator Consortium (VSSCC)

Launched in 2009, the VSSCC (subset of Acute Committee):– Promotes evidenced based stroke care in all hospitals in the

Commonwealth– To improve collaborative partnerships with EMS– To share resources, tools, innovative ideas and technology– To provide a forum for stroke coordinators to ask questions

and receive timely researched expert answers via the Virginia Stroke Systems Ambassadors Panel

– To communicate efforts within the VSSTF– To inform the community about stroke signs

and symptoms and prevention

Virginia Stroke Systems Coordinator Consortium (VSSCC)

The VSSCC is chaired by Pat Lane, RN Neuroscience Coordinator of Bon Secours St. Francis Medical Center.

– The VSSCC is divided into six (6) regions correlating with EMS Virginia Hospital regions.

– The Chair meets monthly with the region leaders to discuss regional issues, best practices, updates from VSSTF and plan future agenda items.

– The VSSCC meets every other month either via conference call or webinars and has at least one face to face meeting per year coinciding with an educational seminar.

For information about future meetings contact Tiffany Baul at 804-965-6570 or Tiffany.Baul@heart.org. This group is supported and funded by the Virginia Department of Health Heart Disease and Stroke Prevention Project and the American Heart Association.

EMS Triage WorkplanEmergency Medical Services (EMS) operators and dispatchers play a critical role in recognizing stroke and determining the timing and type of the EMS response to stroke in that complex process. It involves interaction among the public, EMS programs and the appropriate hospital Emergency Department (ED).

A systems approach that enables rapid identification of stroke and the appropriate response of EMS operators and dispatchers can have a significant impact on improving stroke outcomes. The system can greatly benefit from:–The public’s ability to recognize a stroke–Rapid response to stroke calls through EMS operators– Implementation of measures that decrease call time and increase

appropriate response–Establishment of programs for ongoing education and stroke-specific

training of EMS personnel–Establishment of standard stroke protocols–Coordination of air transport options with EMS

A comprehensive, coordinated statewide emergency medical services plan for the Virginia Office of Emergency Services can be found at: www.vdh.state.va.us/OEMS/EMSPlan/StrategicAndOperationalPlan.pdf

Telemedicine LegislationVirginia Senate Bill 675: April 2010 § 38.2-3418.16: Insurance coverage for mandated telemedicine services.

“Requires health insurers, health care subscription plans, and health maintenance organizations to provide coverage for the cost of such health

care services provided through telemedicine services. "Telemedicine services" means the use of interactive audio, video, or other electronic media for the purpose of diagnosis, consultation, or treatment. Utilization review may be undertaken to determine the

appropriateness of telemedicine services.”

Essence: All patients insured by PRIVATE PAYERS in Virginia, regardless of where the patient lives, must reimburse identically to what they would have for a "face-to-face" encounter.

All MEDICAID insured patients regardless where they live in Virginia qualify for TM reimbursement. MEDICARE will reimburse nationally for ONLY RURAL (federally defined) patient care provided by telemedicine services (some stipulations may apply).

Virginia’s LIS: lis.virginia.gov/cgi-bin/legp604.exe?101+sum+SB675

We look forward to future collaborations!Thank You for the opportunity for us to present

the VSSTF to the VHDSA. Co-Chairs: Dr. Nina Solenski, Associate Professor in Neurology, UVA, 434-924-

8374 or njs2j@hscmail.mcc.virginia.edu

Dr. Richard Zweifler, Chief of Neurology, Sentara Health and Professor of Neurology at Eastern Virginia Medical School, 757-388-6133, rmzweifl@sentara.com

Community Education & Web Team Chair:Rev. Andrea LomboyExecutive Director of the Congregational Health ReSource/Stroke

Telemedicine and Tele-education Coordinator, UVA703/581-4323, alomboy@faithbasedhealth.com, or

alomboy@virginia.edu